Circulation. 2002;106:945-949
Published online before print August 5, 2002, doi: 10.1161/01.CIR.0000027565.12764.E1
Published online before print August 5, 2002, doi: 10.1161/01.CIR.0000027565.12764.E1
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 2002;106:945.)
© 2002 American Heart Association, Inc.
Clinical Investigation and Reports |
Exercise-Induced Increase in Baroreflex Sensitivity Predicts Improved Prognosis After Myocardial Infarction
From Centro Medico di Montescano (M.T.L.R., M.G.), Fondazione "Salvatore Maugeri" IRCCS, Montescano, Pavia; Department of Cardiology (C.B., M.G., P.J.S.), University of Pavia and Policlinico S Matteo IRCCS, Pavia; and Division of Cardiology (G.S.), Policlinico di Monza, Italy.
Correspondence to Peter J. Schwartz, MD, FAHA, Professor and Chairman, Department of Cardiology, Policlinico S Matteo IRCCS, V le Golgi, 19, 27100 Pavia, Italy. E-mail PJQT{at}compuserve.com
Background— Despite the rational expectation for a survival benefit produced by exercise training among post–myocardial infarction (MI) patients, direct evidence remains elusive. Clinically, changes in autonomic balance toward lower vagal activity have consistently been associated with increased mortality risk; conversely, among both control and post-MI dogs, exercise training improved vagal reflexes and prevented sudden death. Accordingly, we tested the hypothesis that exercise training, if accompanied by a shift toward increased vagal activity of an autonomic marker such as baroreflex sensitivity (BRS), could reduce mortality in post-MI patients.
Methods and Results— Ninety-five consecutive male patients surviving a first uncomplicated MI were randomly assigned to a 4-week endurance training period or to no training. Age (51±8 versus 52±8 years), site of MI (anterior 41% versus 43%), left ventricular ejection fraction (52±13 versus 51±14%), and BRS (7.9±5.4 versus 7.9±3.4 ms/mm Hg) did not differ between the two groups. After 4 weeks, BRS improved by 26% (P=0.04) in trained patients, whereas it did not change in nontrained patients. During a 10-year follow-up, cardiac mortality among the 16 trained patients who had an exercise-induced increase in BRS 
3 ms/mm Hg (responders) was strikingly lower compared with that of the trained patients without such a BRS increase (nonresponders) and that of the nontrained patients (0 of 16 versus 18 of 79 [23%], P=0.04). Cardiac mortality was also lower among responders irrespective of training (4% versus 24%, P=0.04).
Conclusions— Post-MI exercise training can favorably modify long-term survival, provided that it is associated with a clear shift of the autonomic balance toward an increase in vagal activity.
Key Words: baroreceptors • death, sudden • exercise • myocardial infarction • nervous system, autonomic
This article has been cited by other articles:
 |
|
 |
|
  G. E. Billman Cardiac autonomic neural remodeling and susceptibility to sudden cardiac death: effect of endurance exercise training Am J Physiol Heart Circ Physiol, October 1, 2009; 297(4): H1171 - H1193. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y. C. Tzeng, P. Y. W. Sin, S. J. E. Lucas, and P. N. Ainslie Respiratory modulation of cardiovagal baroreflex sensitivity J Appl Physiol, September 1, 2009; 107(3): 718 - 724. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. C. Hardwick, C. N. Baran, E. M. Southerland, and J. L. Ardell Remodeling of the guinea pig intrinsic cardiac plexus with chronic pressure overload Am J Physiol Regulatory Integrative Comp Physiol, September 1, 2009; 297(3): R859 - R866. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. C. Parrish, E. N. Alston, H. Rohrer, S. M. Hermes, S. A. Aicher, P. Nkadi, W. R. Woodward, J. Stubbusch, R. T. Gardner, and B. A. Habecker Absence of gp130 in dopamine {beta}-hydroxylase-expressing neurons leads to autonomic imbalance and increased reperfusion arrhythmias Am J Physiol Heart Circ Physiol, September 1, 2009; 297(3): H960 - H967. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. L. Ardell, R. Cardinal, M. Vermeulen, and J. A. Armour Dorsal spinal cord stimulation obtunds the capacity of intrathoracic extracardiac neurons to transduce myocardial ischemia Am J Physiol Regulatory Integrative Comp Physiol, August 1, 2009; 297(2): R470 - R477. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Braunschweig, C. Linde, P. B. Adamson, A. Magalski, E. Erdmann, B. Kjellstrom, and T. Bennett Continuous central haemodynamic measurements during the six-minute walk test and daily life in patients with chronic heart failure Eur J Heart Fail, June 1, 2009; 11(6): 594 - 601. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Komine, J. Sugawara, K. Hayashi, M. Yoshizawa, and T. Yokoi Regular endurance exercise in young men increases arterial baroreflex sensitivity through neural alteration of baroreflex arc J Appl Physiol, May 1, 2009; 106(5): 1499 - 1505. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. C. Tzeng, P. Y. W. Sin, and D. C. Galletly Human sinus arrhythmia: inconsistencies of a teleological hypothesis Am J Physiol Heart Circ Physiol, January 1, 2009; 296(1): H65 - H70. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. C. Hardwick, E. M. Southerland, and J. L. Ardell Chronic myocardial infarction induces phenotypic and functional remodeling in the guinea pig cardiac plexus Am J Physiol Regulatory Integrative Comp Physiol, December 1, 2008; 295(6): R1926 - R1933. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. U. Viola, L. M. James, S. N. Archer, and D.-J. Dijk PER3 polymorphism and cardiac autonomic control: effects of sleep debt and circadian phase Am J Physiol Heart Circ Physiol, November 1, 2008; 295(5): H2156 - H2163. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B.-Y. Li, G.-F. Qiao, B. Feng, R.-B. Zhao, Y.-J. Lu, and J. H. Schild Electrophysiological and neuroanatomical evidence of sexual dimorphism in aortic baroreceptor and vagal afferents in rat Am J Physiol Regulatory Integrative Comp Physiol, October 1, 2008; 295(4): R1301 - R1310. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Iellamo, M. Pagani, and M. Volterrani Cardiac Rehabilitation and Prevention of Cardiovascular Disease: A Role for Autonomic Cardiovascular Regulation J. Am. Coll. Cardiol., September 23, 2008; 52(13): 1105 - 1105. [Full Text] [PDF]
|
|
|
|
|
|
P. J. Schwartz, G. M. De Ferrari, A. Sanzo, M. Landolina, R. Rordorf, C. Raineri, C. Campana, M. Revera, N. Ajmone-Marsan, L. Tavazzi, et al. Long term vagal stimulation in patients with advanced heart failure First experience in man Eur J Heart Fail, September 1, 2008; 10(9): 884 - 891. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. A. Dawson, D. Li, T. Woodward, Z. Barber, L. Wang, and D. J. Paterson Cardiac cholinergic NO-cGMP signaling following acute myocardial infarction and nNOS gene transfer Am J Physiol Heart Circ Physiol, September 1, 2008; 295(3): H990 - H998. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. G. J. Gademan, R. J. van Bommel, C. Ypenburg, J. C. W. Haest, M. J. Schalij, E. E. van der Wall, J. J. Bax, and C. A. Swenne Biventricular pacing in chronic heart failure acutely facilitates the arterial baroreflex Am J Physiol Heart Circ Physiol, August 1, 2008; 295(2): H755 - H760. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. J. Schwartz, E. Vanoli, L. Crotti, C. Spazzolini, C. Ferrandi, A. Goosen, P. Hedley, M. Heradien, S. Bacchini, A. Turco, et al. Neural control of heart rate is an arrhythmia risk modifier in long QT syndrome. J. Am. Coll. Cardiol., March 4, 2008; 51(9): 920 - 929. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. M. De Ferrari, A. Sanzo, A. Bertoletti, G. Specchia, E. Vanoli, and P. J. Schwartz Baroreflex Sensitivity Predicts Long-Term Cardiovascular Mortality After Myocardial Infarction Even in Patients With Preserved Left Ventricular Function J. Am. Coll. Cardiol., December 11, 2007; 50(24): 2285 - 2290. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Khattab, A. A. Khattab, J. Ortak, G. Richardt, and H. Bonnemeier Iyengar Yoga Increases Cardiac Parasympathetic Nervous Modulation Among Healthy Yoga Practitioners Evid. Based Complement. Altern. Med., December 1, 2007; 4(4): 511 - 517. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. J. Holycross, M. Kukielka, Y. Nishijima, R. A. Altschuld, C. A. Carnes, and G. E. Billman Exercise training normalizes beta-adrenoceptor expression in dogs susceptible to ventricular fibrillation Am J Physiol Heart Circ Physiol, November 1, 2007; 293(5): H2702 - H2709. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. J. Schwartz and E. Vanoli From exercise training to sudden death prevention via adrenergic receptors Am J Physiol Heart Circ Physiol, November 1, 2007; 293(5): H2631 - H2633. [Full Text] [PDF]
|
|
|
|
 |
|
 J. A Blumenthal, A. Sherwood, S. D. Rogers, M. A. Babyak, P. Murali Doraiswamy, L. Watkins, B. M. Hoffman, C. O'Connell, J. J. Johnson, S. M. Patidar, et al. Understanding prognostic benefits of exercise and antidepressant therapy for persons with depression and heart disease: the UPBEAT study rationale, design, and methodological issues Clinical Trials, October 1, 2007; 4(5): 548 - 559. [Abstract] [PDF]
|
|
|
|
 |
|
 S. B.C. Souza, K. Flues, J. Paulini, C. Mostarda, B. Rodrigues, L. E. Souza, M.-C. Irigoyen, and K. De Angelis Role of Exercise Training in Cardiovascular Autonomic Dysfunction and Mortality in Diabetic Ovariectomized Rats Hypertension, October 1, 2007; 50(4): 786 - 791. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Herigstad, G. M. Balanos, and P. A. Robbins Can human cardiovascular regulation during exercise be learnt from feedback from arterial baroreceptors? Exp Physiol, July 1, 2007; 92(4): 695 - 704. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. C. Laterza, L. D.N.J. de Matos, I. C. Trombetta, A. M.W. Braga, F. Roveda, M. J.N.N. Alves, E. M. Krieger, C. E. Negrao, and M. U.P.B. Rondon Exercise Training Restores Baroreflex Sensitivity in Never-Treated Hypertensive Patients Hypertension, June 1, 2007; 49(6): 1298 - 1306. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. van de Vooren, M. G. J. Gademan, C. A. Swenne, B. J. TenVoorde, M. J. Schalij, and E. E. Van der Wall Baroreflex sensitivity, blood pressure buffering, and resonance: what are the links? Computer simulation of healthy subjects and heart failure patients J Appl Physiol, April 1, 2007; 102(4): 1348 - 1356. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J-P Schmid, M Noveanu, R Gaillet, G Hellige, A Wahl, and H Saner Safety and exercise tolerance of acute high altitude exposure (3454 m) among patients with coronary artery disease Heart, July 1, 2006; 92(7): 921 - 925. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. E. Billman and M. Kukielka Effects of endurance exercise training on heart rate variability and susceptibility to sudden cardiac death: protection is not due to enhanced cardiac vagal regulation J Appl Physiol, March 1, 2006; 100(3): 896 - 906. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Fantoni, S. Raffa, F. Regoli, F. Giraldi, M. T. La Rovere, J. Prentice, F. Pastori, S. Fratini, J. A. Salerno-Uriarte, H. U. Klein, et al. Cardiac Resynchronization Therapy Improves Heart Rate Profile and Heart Rate Variability of Patients With Moderate to Severe Heart Failure J. Am. Coll. Cardiol., November 15, 2005; 46(10): 1875 - 1882. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Falcone, M. P. Buzzi, C. Klersy, and P. J. Schwartz Rapid Heart Rate Increase at Onset of Exercise Predicts Adverse Cardiac Events in Patients With Coronary Artery Disease Circulation, September 27, 2005; 112(13): 1959 - 1964. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. M. Bassan, I. G. Harnik, X. Jouven, J. P. Empana, and P. Ducimetiere Heart-Rate Profile during Exercise as a Predictor of Sudden Death N. Engl. J. Med., August 18, 2005; 353(7): 734 - 735. [Full Text] [PDF]
|
|
|
|
 |
|
 Z. Lenard, P. Studinger, B. Mersich, G. Pavlik, and M. Kollai Cardiovagal autonomic function in sedentary and trained offspring of hypertensive parents J. Physiol., June 15, 2005; 565(3): 1031 - 1038. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
X. Jouven, J.-P. Empana, P. J. Schwartz, M. Desnos, D. Courbon, and P. Ducimetiere Heart-Rate Profile during Exercise as a Predictor of Sudden Death N. Engl. J. Med., May 12, 2005; 352(19): 1951 - 1958. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Mimura, F. Yuasa, R. Yuyama, A. Kawamura, M. Iwasaki, T. Sugiura, and T. Iwasaka The Effect of Residential Exercise Training on Baroreflex Control of Heart Rate and Sympathetic Nerve Activity in Patients With Acute Myocardial Infarction Chest, April 1, 2005; 127(4): 1108 - 1115. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. R. Ricardo, M. B. de Almeida, B. A. Franklin, and C. G. S. Araujo Initial and Final Exercise Heart Rate Transients: Influence of Gender, Aerobic Fitness, and Clinical Status Chest, January 1, 2005; 127(1): 318 - 327. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. H.M. Kupper, G. Willemsen, M. van den Berg, D. de Boer, D. Posthuma, D. I. Boomsma, and E. J.C. de Geus Heritability of Ambulatory Heart Rate Variability Circulation, November 2, 2004; 110(18): 2792 - 2796. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 O. Manfrini, G. Morgagni, C. Pizzi, F. Fontana, and R. Bugiardini Changes in autonomic nervous system activity: spontaneous versus balloon-induced myocardial ischaemia Eur. Heart J., September 1, 2004; 25(17): 1502 - 1508. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. W. Raymond Vagal Pas de Deux: Heart-Lung Interplay in Postexercise Heart Rate Recovery Chest, April 1, 2004; 125(4): 1186 - 1190. [Full Text] [PDF]
|
|
|
|
|
|
D. B. Mark and M. S. Lauer Exercise Capacity: The Prognostic Variable That Doesn't Get Enough Respect Circulation, September 30, 2003; 108(13): 1534 - 1536. [Full Text] [PDF]
|
|
|
|
 |
|
 P. M. Lehrer, E. Vaschillo, B. Vaschillo, S.-E. Lu, D. L. Eckberg, R. Edelberg, W. J. Shih, Y. Lin, T. A. Kuusela, K. U. O. Tahvanainen, et al. Heart Rate Variability Biofeedback Increases Baroreflex Gain and Peak Expiratory Flow Psychosom Med, September 1, 2003; 65(5): 796 - 805. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Abidov, R. Hachamovitch, S. W. Hayes, C. K. Ng, I. Cohen, J. D. Friedman, G. Germano, and D. S. Berman Prognostic Impact of Hemodynamic Response to Adenosine in Patients Older Than Age 55 Years Undergoing Vasodilator Stress Myocardial Perfusion Study Circulation, June 17, 2003; 107(23): 2894 - 2899. [Abstract] [Full Text] [PDF]
|
|